Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice
Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice
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DOI：
10.1016/s0016-5107(99)70339-1
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发表时间：
1999-07-01
影响因子：
7.7
通讯作者：
Ulbright, TM
中科院分区：
文献类型：
--
作者：
Alikhan, M;Rex, D;Ulbright, TM
背景资料：柱状内衬食管活检标本的病理学解释指导随后的内窥镜监测和/或手术干预。本研究的目的是评估病理解释的柱状内衬食管的一般病理学家在社区practice.Methods：五个组织切片代表不同类型的柱状内衬食管提交审查20个随机选择的一般病理学家在社区practice. Methods。肠化3例结果：30%的病理学家认为高度异型增生为浸润性腺癌，20%认为低度异型增生，30%认为中度异型增生，20%认为浸润性腺癌。低度异型增生被35%的病理学家确定为低度异型增生，20%被称为高度异型增生，20%为中度异型增生，25%为无异型增生。无异型增生的特化柱状上皮被确定为35%，称为低度异型增生35%，中度异型增生15%，不确定异型增生10%，浸润性腺癌5%。胃上皮化生没有专门的柱状上皮被确定为Barrett食管cases.Conclusions的38%：柱状内衬食管由社区病理学家的病理解释可能会受到显着interobserver变化。Barrett食管常用于描述无杯状细胞的柱状食管。由于这一发现与癌症风险增加没有明显联系，这些数据支持最近的建议，即放弃Barrett食管。高度和低度异型增生的解释应考虑由食管病理学专家审查。
Background: Pathologic interpretation of biopsy specimens of columnar lined esophagus guides subsequent endoscopic surveillance and/or surgical intervention. The aim of this study was to evaluate pathologic interpretation of columnar lined esophagus by general pathologists in community practice.Methods: Five histologic slides representing different types of columnar lined esophagus were submitted for review by 20 randomly selected general pathologists in community practice. There were three cases with intestinal metaplasia (one with no dysplasia, one with low-grade dysplasia, and one with high-grade dysplasia) and two cases of gastric metaplasia (one fundic-type and one cardia-type).Results: High-grade dysplasia was identified as such by 30% of pathologists and was called invasive adenocarcinoma by 20%, low-grade dysplasia by 30%, and moderate dysplasia by the remaining 20%. Low-grade dysplasia was identified as such by 35% of pathologists and was called high-grade dysplasia by 20%, moderate dysplasia by 20%, and no dysplasia by 25%. Specialized columnar epithelium with no dysplasia was identified as such by 35%, called low-grade dysplasia by 35%, moderate dysplasia by 15%, indeterminate for dysplasia by 10%, and invasive adenocarcinoma by 5%. Gastric metaplasia without specialized columnar epithelium was identified as Barrett's esophagus in 38% of cases.Conclusions: Pathologic interpretation of columnar lined esophagus by community pathologists may be subject to marked interobserver variation. The term Barrett's esophagus is often used to describe columnar lined esophagus without goblet cells. Because this finding is not clearly associated with an increased risk of cancer, these data support recent suggestions that the term Barrett's esophagus be abandoned. Interpretations of both high-grade and low-grade dysplasia should be considered for review by experts in esophageal pathology.